Insurance follow up representative job description

-Responsible for 50 - 60 claims per day

-Reach out to Medicaid/Medicare and commercial payors

-Professional candidate with extensive Revenue Cycle experience

-Duties include editing claims, billing out claims, following up with insurance companies, appeals, denials, collections, and payment posting

-Familiar with Medicare, Medicaid and BCBS payors

-Has used EPIC and Availity

-Understands EOB's

Hours: 7:30am-3:30pm during training. After training, they choose to work 7:00am-3:00pm, 7:30am-3:30pm, or 8:00am-4:00pm

Top Skills Details:

epic, insurance, EMR, claims

Additional Skills & Qualifications:

MUST HAVES

Insurance experience

Physician claims experience

Experience Level:

Entry Level

About Aston Carter:

Please Note: Scammers are posing as Aston Carter. We'll never contact you via Gmail, Telegram, or WhatsApp and we'll never solicit money from you.

At Aston Carter, we're dedicated to expanding career opportunities for the skilled professionals who power our business. Our success is driven by the talented, motivated people who join our team across a range of positions - from recruiting, sales and delivery to corporate roles. As part of our team, employees have the opportunity for long-term career success, where hard work is rewarded and the potential for growth is limitless.

Established in 1997, Aston Carter is a leading staffing and consulting firm, providing high-caliber talent and premium services to more than 7,000 companies across North America. Spanning four continents and more than 200 offices, we extend our clients' capabilities by seeking solvers and delivering solutions to address today's workforce challenges. For organizations looking for innovative solutions shaped by critical-thinking professionals, visit . Aston Carter is a company within Allegis Group, a global leader in talent solutions.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing process due to a disability, please call or email for other accommodation options. However, if you have questions about this position, please contact the Recruiter located at the bottom of the job posting. The Recruiter is the sole point of contact for questions about this position.

Facility: CHS Services Location: Melville, NY Department: Billing/Follow up Category: Administrative / Business Support Schedule: Full Time Shift: Day shift Hours: M-F 8-4 ReqNum: 6037652

At Catholic Health, our primary focus is the way we treat and serve our communities. We work collaboratively to provide compassionate care and utilize evidence based practice to improve outcomes - to every patient, every time. We are committed to caring for Long Island. Be a part of our team of healthcare heroes. Catholic Health is also proud to be voted one of Newsday's Top Places to Work on Long Island.

Under the direction of the Physician Revenue Realization Manager, the Insurance Follow-Up Representative is responsible for investigating claims status with insurance carriers, correcting and resubmitting denied claims in the EPIC billing system.
Responsibilities:

* Performs follow up on all outstanding accounts assigned in accordance with established standards and procedures.

* Determines reason for denial and appeals accounts as necessary.

* Reviews and edits any rejections stemming from electronic billing submissions and corrects and resubmits claims.

* Verifies accuracy of patient insurance and demographic information.

* Generates bills to patients for services not covered by insurance.

* Investigates over-payments and takes appropriate action to resolve. Initiates refund requests in accordance with departmental procedures.

* Responds to requests for information and telephone inquiries from patients, insurance carriers, and outside agencies in a courteous manner.

* Send secondary claims to appropriate payors.

Requirements:

* High School diploma or equivalent required.

* Strong knowledge of medical insurance and healthcare billing

* Establishes and demonstrates competency in accounts receivable systems and associated applications

* Ability to communicate effectively with insurance carriers, patients, and co-workers

* Ability to comply with procedural guidelines and instructions and to solicit assistance when situations arise that deviate from the norm.

* Excellent verbal and auditory skills are required for communicating with internal staff, customers and representatives from external departments and agencies.

* Minimum of 3 years of Physician Billing experience, including insurance carrier follow up and customer service, required.

At Catholic Health your well-being comes first, with comprehensive compensation and benefits; our offerings go beyond the basics. In addition to multiple medical plans, life insurance, generous paid time off and flexible spending accounts, we also offer substantial tuition reimbursement, an employer funded pension plan and several savings plan options for your future.

Oregon Medical Group offers a competitive compensation and benefits package including:

* Low cost medical, dental, and vision insurance with $0 copay when seeing an OMG provider
* 401(k) retirement plan with employer match
* Paid Time Off - 4.6 weeks to start
* Education assistance and tuition reimbursement
* Company paid corporate gym membership
* Company paid short term disability

PURPOSE OF POSITION: The Billing & Insurance Follow Up Representative serves the patients, clinicians, and staff of Oregon Medical Group by analyzing outstanding receivables including no response/rejected medical claims and ensuring affected claims are promptly followed-up with, resulting in the reduction of outstanding balances, increased reimbursement, and the mitigation of unnecessary write offs.

EXAMPLES OF DUTIES:

* Apply billing and coding principles consistent with government regulatory standards, payer specific guidelines, and OMG policy.
* Resolve outstanding receivables by investigating no response and rejected medical claims while maintaining productivity figures at or exceeding defined metrics after orientation period.
* Perform follow up actions including correcting payer rejections, checking claim status, updating patient registration related items, and rebilling claims as necessary to ensure claims are processing in a timely fashion; escalate issues as appropriate to Senior Billing and Insurance Follow Up Representatives or leadership.
* Analyze payer responses and correct as appropriate to ensure accurate responses are recorded per explanation of payments which may include taking or reversing adjustments and transferring payments or balances.
* Collaborate with other Revenue Cycle or operational teams to resolve customer service or reimbursement related issues including talking directly with patients and gathering documentation to assist other team members with their books of work.
* Maintain strictest confidentiality.
* Work on assigned projects as needed.
* Perform other duties as assigned.

Experience and Skills:

PERFORMANCE REQUIREMENTS:

* Knowledge of reimbursement and claims processing procedures to include billing and payer related policies.
* Knowledge of CPT, HCPCS, and ICD-10.
* Ability to consistently meet defined productivity expectations after orientation period.
* Knowledge of clinic operating policies to help in the identification of denial root causes.
* Skill in using computers including Microsoft Office products. Must be able to utilize standard office technologies including dual monitors, phone systems, 10-Key, and internet based tools; ability to learn new systems.
* Able to examine documents for accuracy and completeness including preparing records in accordance with detailed instructions.
* Ability to work effectively with patients and co-workers; communicate clearly, both verbally and in writing.

EDUCATION: Equivalent of a high school diploma.

EXPERIENCE: 1-2 years' experience in medical billing office, to include processing claims and a working knowledge of CPT, ICD-10 and HCPCS coding. EPIC EMR experience is preferred.

Full COVID-19 vaccination is an essential requirement of this role. Oregon Medical Group will adhere to all federal, state and local regulations and will obtain necessary proof of vaccination prior to employment to ensure compliance.

TYPICAL PHYSICAL DEMANDS: Requires sitting for prolonged periods of time and some bending, stooping and stretching. Requires hand-eye coordination and manual dexterity necessary for the operation of basic office equipment such as a computer, calculator, photo copier and telephone. May be required to lift up to 25 pounds. Requires the ability to work quickly and accurately under stress.

TYPICAL WORKING CONDITIONS: Work is performed in an office environment. Involves frequent contact with patients and internal staff.

About Oregon Medical Group

Oregon Medical Group provides patients with a single point of access to a full range of comprehensive and coordinated health care, including primary care, pediatrics and over 20 other specialties. Supporting services include on-site labs and x-ray services, a state-of-the-art imaging department, physical therapy, infusion center and more. OMG emphasizes preventative care and healthy living as it cares for patients. Addressing the cause of health issues is as important as treating symptoms; many OMG patients credit their physicians and clinicians for support with health, fitness and other lifestyle choices. Founded in 1988, OMG physicians, clinicians and staff provide care from 10 locations across the Eugene and Springfield areas to help our patients live their healthiest lives. Learn more at OregonMedicalGroup.com.

* Our Mission: We collaborate to provide the highest quality, patient-centered care.
* Our Vision: Together, we help you live your healthiest life.
* Our Values: Servant Leadership - Professionalism - Sustainability